3-Quinuclidinyl Benzilate Poisoning Follow-up

Updated: Apr 10, 2015
  • Author: Christopher P Holstege, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
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Follow-up

Further Inpatient Care

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  • Inpatient care is no different than that discussed in Emergency Department Care. Keep symptomatic patients who were exposed to QNB in a monitored setting until their symptoms completely resolve. Use of maintenance intravenous fluids and sedatives such as benzodiazepines may be necessary. Prolonged intoxication may occur depending on the dose of QNB absorbed.

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Transfer

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  • Any health care facility that is unable to adequately monitor a patient intoxicated with an anticholinergic should consider transfer to a facility that can care for such patients.

  • Smaller health care facilities may be overwhelmed if a large-scale terrorist attack with multiple victims occurs. Disaster plan implementation and appropriate transfer of patients to less stressed facilities may be necessary.

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Complications

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  • Rhabdomyolysis: If a person exposed to QNB develops marked agitation or profound somnolence, tissue necrosis may occur and rhabdomyolysis may develop. If this remains undiagnosed, myoglobinuric renal failure may develop.

  • Anoxic brain injury: If an exposed person becomes comatose and loses his or her ability to maintain ventilatory function, hypoxia may develop and lead to anoxic brain injury.

  • Aspiration pneumonia: Inability of exposed patients to maintain their airway may result in aspiration of gastric contents into the lungs.

  • Ileus: The prolonged anticholinergic effects of QNB may lead to development of an ileus.

  • Angle-closure glaucoma: Those patients predisposed may be at risk due to the mydriasis induced by QNB.

  • Bleeding diathesis: Disseminated intravascular coagulation may develop in patients with shock and marked hyperthermia.

  • Hepatic injury: Hepatic injury may accompany antimuscarinic agent toxicity that involves hyperthermia or shock.

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Prognosis

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  • The prognosis is good for QNB-exposed patients if they do not develop a secondary injury such as the complications noted above. Once they are removed from the exposure and the absorbed QNB is metabolized, they should become more lucid. Full recovery is expected within 4 days. No long-term effects are expected from QNB itself.

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Patient Education

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